January 17, 2021

Risky Business

Risky Business

In the name of beauty

A doctor billed insurance companies in the names of dozens of surgeries while performing cosmetic procedures for his patients. He billed hernia surgeries for tummy tucks, deviated septum fixings for rhinoplasty and many others. The insurance company suspected fraud and decided to investigate. Sound familiar?


Double Trouble

An insured and her daughter claimed disability injuries from playing football, falling from a ladder and snake bite. The duo claimed at different times with their insurer, citing the same claims. The insurance team investigated both sets of similar claims and found that they had not been admitted or treated...


Collision course

A woman struck a railing while driving on the highway, but was uninsured at the time. She went home, applied for a motor insurance policy but did not report the accident. Three weeks later she filed a claim with her insurer for another similar collision with a guard rail. Unaware...


Caught by the metadata

An insured reported a claim to his homeowner’s insurance company indicating roof damage from a storm. He submitted photos as evidence of the purported damage. When the insurers checked the metadata of the photos they were found to be years older than the policy and the insured’s ownership of the...


Street racer

An insured decided to race on the street and was rammed on the side which caused him to lose control and collide with a building resulting in causing damage to two other vehicles. However he gave a different story to his insurance company and was paid for his claim. However,...


The claim that never was

A woman filed a claim suggesting she was a victim of theft and vandalism and had electrical issues in her house. She filed these claims with three different companies in order to get the maximum compensation for her claim. When the claim was investigated, it was found to be bogus,...


Not so sick

Two Navy officers made false claims to their group life insurance programme for unearned benefits. Unfortunately for them, their plan was found, they were taken off the service and sent to prison.


Lost and paid

A man lost his licence to practice as an agent but he did not discontinue what he did. He set up his own agency, entered into a contract with an insurance company and used his position to steal premiums. The insurer uncovered the scheme seven years later and put an...


Off the books

Two trucking company owners decided to underpay their employees by classifying them as independent contractors to avoid high workers’ compensation premiums. They paid lower insurance premiums and increased their income…until the insurance company caught on to the grand scheme and decided to make them pay.


Wedding woes

A couple whose wedding was shelved by their venue partner due to the pandemic and resulting social distancing norms were asked to pay for 80 percent of the cancellation charge. To top it off, their insurance claim was rejected due to the closure resulting from a government order. However the...

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